Healthcare system in Kenya under political unrest

The healthcare system in Kenya is currently facing a major crisis as doctors across the country participate in a strike over poor pay and working conditions. This ongoing unrest has had serious implications for the delivery of healthcare services to the Kenyan population, with hospitals struggling to operate at full capacity.

A tide of protests rocked Kenya in January, 2024, with thousands of people going on rampage, in support of the independence of the judiciary and women’s rights. As legions of demonstrations were reported throughout the country, January struck an all-time high in the number of demonstrations recorded in Kenya, since July 2023, when legions of Kenyans demonstrated against the skyrocketing levels of the cost of living and new taxes. President William Ruto was at the epicentre of a dispute with the High Court Judges.

Of late, yet another wave of protests lingers on. This only leaves us wondering whether or not the latest life-threatening protests will soon see an amicable, diplomatic compromise between the aggrieved parties. Time will be the unique narrator of this story.

It so follows that, myriads of Medical Practitioners and other medical support staff took part in demonstrations, on the streets of Nairobi, on Friday, March 22, 2024. They were demanding better pay and working conditions, in an ongoing nationwide strike, that had gotten into its second consecutive week. It was during this time period that I started trailing the doctor’s demonstrations with undivided attention.

It is noteworthy to ascertain that this is by no means the first time that Kenyan doctors are demonstrating over poor pay and working conditions. Way back in 2017, the medical practitioners partook of a 100-day go-slow, that saw people dying from lack of medical attention. The strike was brokered with an agreement that was signed between the doctors’ union and the government, stipulating that the government would increase their pay and create better conducive working conditions.

However, the Doctors believe that they were ‘hood-winked’, as they now confirm that part of what was agreed upon, in 2017 has not been honored down to this date!

The medical practitioners were seen carrying placards, as they chanted anti-government slogans, stating that it had failed to implement a good deal of promises, notwithstanding a collective bargaining agreement, which was signed in 2017 during Uhuru Kenyatta’s presidency, in the aftermath of a hundred-day strike, that left many patients deceased, with others maimed, from a lack of medical attention.

The Kenya Medical Practitioners, Pharmacists and Dentists Union Secretary-General, Dr. Davji Atellah stated that the demonstrations would be pursued, until all their demands were adhered to.

Casualties have been counted as the standoff between the medical practitioners and the government rages on. It has definitely left many Kenyans without public health care services, as many patients are turned away from public hospitals and other pass on in the process.

In a new twist, the Cabinet Secretary for Health, Susan Nakhumicha released a press statement, indicating that she had instructed two top referral hospitals to recruit new doctors, who would replace all those partaking of the abominable anti-government nation-wide demonstrations.

Dr. Davji Atellah, the Union secretary fired back, by countering Secretary Nakhumicha’s statement, and underscoring the fact that the hiring of new doctors would by no means solve the underlying grievances that instigated the strike in the first place.

On Thursday, the 21st of March, on the eve of the Friday demonstrations, that drew me in as an active spectator, the medical practitioners had downed their tools and cut off the dispensing of emergency services at many a public hospital, as the demonstrations skyrocketed. This was in spite of a pending court order, which called for a compromise, hence a balanced dialogue between the Doctors Union and the Ministry of Health.

Concurrently, on the same eve of the Friday demonstrations, the government attempted to quell the go-slow, by sending its head of the Public Service, Mr. Felix Kosgei, to hold a consultative meeting with the health union officials and other diverse ministries. The Public Service secretary harped upon the fact that the government would be willing to implement the 2017 collective bargaining agreement, as pertains to the doctor’s strike. However, owing to financial constraints, this agreement would only be implemented progressively and in phases.

As it now stands, however, four weeks down the line, the Kenyan health system continues to be severely crippled as the doctors’ strike ushered in its fourth consecutive week, with the government’s unwavering stand that it would not yield to the demands for pay increment.

Addressing a press conference earlier this week of April the 7th, on Sunday, 2024, President Ruto recapitulated that the government was in no position of implementing the raise in the doctors’ salaries as set forth by the 2017 collective bargaining agreement between the government and the Kenya Medical Practitioners, Pharmacists and Dentists Union (KMPDU).

Noteworthy, the government is only but availing a gross monthly wage of between Kenyan shillings 45 000-70 000 for interns, as opposed to the Ksh206 000 specified in the 2017 collective bargaining agreement.

Surmise is to say that, in the health care sector, the main prevalent challenges in the post devolution era include inadequate resources, (hence funding from the national government), not to mention the under-staffed healthcare facilities, a lack of medication, lack of beds to hold a high capacity of patients in some facilities-the likes of Kenyatta National Hospital or at the Jaramogi Oginga Odinga Teaching and Referral Hospital in Kisumu city, if just to mention but a few.

The solution to counter these challenges, would be to inject more financial resources to the corresponding counties, as commensurate with the devolved functions and their respective population as per the national census of the active budget year.

The political and social implications of the doctor’s strike in Kenya exposes an unemployment crisis, in which qualified medical graduates are grappling to secure jobs, despite under-staffing at most local public hospitals, owing to the government’s budgetary deficiency.

The go-slow advances in the wake of Kenya’s prospective funding limitations from donors, occasioned by a rising debt repayment arrears, as stated by the country’s parliamentary budget office. A fair few of 4,000 public sector doctors are on go-slow, as stated by the Kenya Medical Practitioners Pharmacists Dentists Union (KMPDU), just about half of the country’s approximated 9,000 registered doctors.

One of the main grievances is that the union is demanding of the government to hire over 3,000 medical interns, who are forthwith not working, to counter the under-staffing in many medical facilities. Nonetheless, the health ministry maintains that it is deficient of the resources to engage the latter, and in March of 2024, solicited for 4.9 billion Kenyan shillings ($37.7 million) from the treasury for this sole purpose. This translates to the fact that regardless of a blueprint compelling the government to absorb medical interns, within a time frame of thirty days, upon the completion of their education, graduates still remain unemployed for some lengthy time span, despite being eligible to practice medicine.

The union has held the government liable of lingering for years on end, dilly-darling with the implementation of an agreement signed in 2017, that, amongst other things, sets medical interns’ salaries at 206,000 Kenyan shillings per month and fast tracks their clearance to work at health facilities upon graduation. Nonetheless, the Health Cabinet Secretary Susan Nakhumicha told reporters way back in March that the internship controversy portrayed “a bigger conversation about health care financing.”

Dr. Davji Atellah, the secretary general of the KMPDU indicated in a press conference that the government was literally ‘taking them in circles’ with no plans whatsoever to address the incidental issues, and that they have not prioritized the healthcare workforce. The doctors’ union has remained adamant, and on Tuesday, the 9th of April, 2024, reiteratively, myriads of doctors took part in the latest round of protests and presented a petition to parliament exhorting legislators to intercede in their labor dispute.

As per today, the news has it that a public hospital in Kenya’s capital, Nairobi, has unceremoniously dismissed 100 doctors who were partaking of the nationwide go-slow that has been perennial for almost a month.

The Kenyatta University Referral Hospital reported that new doctors had been hired in place of those striking. No similar news has been gathered from any other public medical facility across the country, though we have to admit that as the feud rages on, we are going to experience casualties on both parties.

Lawmakers from the opposite sides of the political divide intimated vexation towards the government’s reciprocation to the health crisis, which has occasioned extensive disorderliness in medical services across the country. The Majority Leader found fault with the devolution Act of health services of 2010, asserting that the devolution did great injustice, not only to the medical profession but to Kenyans alike.

He equally probed and raised the issue as to why county governments, which have reportedly underutilised their budgets, struggle to meet doctors’ demands. On the other hand, the Minority Leader denounced the government’s technique, intimating that the matter in question would be improbable to settle speedily as far as matters are concerned.